Misc

As a physician executive who teaches population health, consults with hospital systems and gives keynotes on disruptive technologies, I keep track of all the consequences of the current transformation of the American healthcare delivery system. As we create a new system that emphasizes value over volume, nobody is smart enough to predict the many opportunities and challenges that occur.

I find Twitter is the best way to make sure that I don't miss out on any of the twists and turns that happen because of the rapid changes taking place in our healthcare industry. By following more than 1,400 healthcare leaders on Twitter, not much of importance escapes my attention.

Three trends recently caught my eye because of links to articles in my tweet stream:

Insurance companies shift their focus to consumers not employers

Medical office leasing arrangements have shifted due to the Affordable Care Act (ACA)

New guidelines call on physicians to use evidence-based medicine guidelines to improve quality and cut costs

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WellPoint, the second largest healthcare insurance company in the United States, announced it will change its name to Anthem. Industry analysts interpret this move as the need for insurers to adapt to the ACA. With the introduction of state insurance exchanges, this sector of the industry must concentrate on individual consumers rather than large employers. Aetna made a similar move in 2012 with a new logo designed for "driving increased consumer engagement in their healthcare." Florida Blue will open retail stores influenced by the success of the Apple stores, and Cigna created an ad campaign focused on individual healthcare consumers.

The Wall Street Journalreported that medical office leasing arrangements shifted from individual leases backed by contracts with individual doctors and small practices, to master leases with large organizations committing to an entire floor or medical office building. This trend reflects the consolidation that occurs throughout the healthcare industry. More and more providers transition from small practices to employment contracts with integrated delivery systems in order to create efficiency and cut the per-capital cost of care.

Dartmouth Professor Jonathan Skinner recently called attention to what he calls "cowboy doctors." Because of the ACA's call for decreased per-capita cost and increased quality of healthcare, physicians who do not follow evidence-based medicine protocols are identified as a major cause of waste in the system. Skinner estimates that such providers account for as much as 17 percent of total variation in healthcare spending which translates into 3 percent of Gross Domestic Product or half a trillion dollars. A National Bureau of Economic Research whitepaper found that these "cowboy doctors" were less likely to be board certified and had no better clinical outcomes than physicians who practiced evidence-based medicine.

All hospital system leaders need to stay on top of the many intended and unintended consequences flowing from the adoption of the ACA and payment reform. Sometimes it seems as though there is too much information to keep track of, but I have found that social media sites like Twitter are a good way to triage reports of health care industry trends. By developing a geographically broad community of healthcare experts, one can identify opportunities and challenges that arise as we all experiment with new ways to delivery healthcare.

Kent Bottles, M.D., is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.